Evaluating the Readability of Online Blood Cancer Education Materials Across Different Readability Measures

Abstract

Introduction The National Institutes of Health and the American Medical Association recommend patient education materials (EMs) be at or below the sixth-grade reading level. The American Cancer Society, Leukemia & Lymphoma Society, and National Comprehensive Cancer Network have accurate blood cancer EMs. Methods One hundred one (101) blood cancer EMs from the above organizations were assessed using the following: Flesch Reading Ease Formula (FREF), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook Index (SMOG), and the Coleman-Liau Index (CLI). Results Only 3.96% of patient EMs scored at or below the seventh-grade reading level in all modalities. Healthcare professional education materials (HPEMs) averaged around the college to graduate level. For leukemia and lymphoma patient EMs, there were significant differences for FKGL vs. SMOG, FKGL vs. GFI, FKGL vs. CLI, SMOG vs. CLI, and GFI vs. CLI. For HPEMs, there were significant differences for FKGL vs. GFI and GFI vs. CLI. Conclusion The majority of patient EMs were above the seventh-grade reading level. A lack of easily readable patient EMs could lead to a poor understanding of disease and, thus, adverse health outcomes. Overall, patient EMs should not replace physician counseling. Physicians must close the gaps in patients' understanding throughout their cancer treatment.

Keywords: blood cancer; leukemia; lymphoma; patient education materials; physician education materials; readability.

Figure 1. FKGL, SMOG, GFI, and CLI scores for all patient EMs

Of all FKGL, SMOG, GFI, and CLI scores for patient EMs, only 1.09% scored at or below the seventh-grade reading level. Of the 1.09%, 100% were calculated by the FKGL formula. FKGL: Flesch-Kincaid Grade Level; SMOG: Simple Measure of Gobbledygook Index; GFI: Gunning Fog Index; CLI: Coleman-Liau Index; EMs: education materials